‘Obamacare’ and rising health premiums

[questionmark]

"Six in 10 Americans are seeing their [health insurance] premiums rise. The average cost of a family policy is up $1,300. Another part of President Obama's health care takeover will cost $111 billion more than promised."

--Voiceover in a Republican National Committee TV ad about the Obama health care law

Be wary of the single data point, exploited either by Democrats or Republicans. Read more...

[Simbi Laveau]

They can fine me.I won't be buying into it.

[George Ford]

We have health care for everyone in the UK. Called the NHS. It is like a giant cancer that is killing off the UK. I think they should introduce a £15.00 fee to see a doctor unless the person is on benefits.

[questionmark]

We have health care for everyone in the UK. Called the NHS. It is like a giant cancer that is killing off the UK. I think they should introduce a £15.00 fee to see a doctor unless the person is on benefits.

In the US they want to take over the German model, which is healthcare for all but you have to buy insurance from an insurance company (unless you can't afford it, then the government pays for you). The UK is healthcare for all paid with taxes

[Michelle]

In the US they want to take over the German model, which is healthcare for all but you have to buy insurance from an insurance company (unless you can't afford it, then the government pays for you). The UK is healthcare for all paid with taxes

I fail to see how that is any different from what we already had. Except insurance premiums have risen to where a lot of people, that have always had it, have had to let it drop. Independent working people and people that own small businesses don't have a chance.

I wish I could remember who said this on UM, but it makes sense to me...solving the health care problem by making people buy insurance, is like solving the homeless problem by making people buy homes.

If we aren't paying $2000 a month for insurance, for the two of us, we don't have a problem paying doctor bills. We just have to pray that nothing catastrophic happens.

[+and-then]

I worked in this industry for about 15 years and have seen up close how broken it is.

Changes will have to come or the wave of baby boomers will crash the system anyway. The uninsured are now a tremendous burden on the rest of working Americans. The poor receive urgent care but do not have access to the kind of health maintenance plans that make urgent care less necessary. My problem with the ACA is that it requires that more services be funded with less money. You cannot add millions of people to the roles and expect the same level of service without drastically expanding the numbers of healthcare workers. I believe this law was designed to give America precisely what Britain has and as Bulveye can attest, it doesn't seem to be working so well there - and they have only a fraction of our population.

[Drayno]

I worked in this industry for about 15 years and have seen up close how broken it is.

Changes will have to come or the wave of baby boomers will crash the system anyway. The uninsured are now a tremendous burden on the rest of working Americans. The poor receive urgent care but do not have access to the kind of health maintenance plans that make urgent care less necessary. My problem with the ACA is that it requires that more services be funded with less money. You cannot add millions of people to the roles and expect the same level of service without drastically expanding the numbers of healthcare workers. I believe this law was designed to give America precisely what Britain has and as Bulveye can attest, it doesn't seem to be working so well there - and they have only a fraction of our population.

Everything seems askew. Social security for the younger generation, I fear, won't exist. Especially with the population increase, and the economic problem to boot. But like all systems, social security will eventually become a dry idea. We had to have anticipated this problem.

[questionmark]

I fail to see how that is any different from what we already had. Except insurance premiums have risen to where a lot of people, that have always had it, have had to let it drop. Independent working people and people that own small businesses don't have a chance.

I wish I could remember who said this on UM, but it makes sense to me...solving the health care problem by making people buy insurance, is like solving the homeless problem by making people buy homes.

If we aren't paying $2000 a month for insurance, for the two of us, we don't have a problem paying doctor bills. We just have to pray that nothing catastrophic happens.

What I don't get is that in other countries they get it together, if we go back to Germany, 90% of the insurance givers are private companies, they are able to provide adequate care for 13% of the family income and they are making money for their investors. Why can't they get it together in the US?

[+and-then]

What I don't get is that in other countries they get it together, if we go back to Germany, 90% of the insurance givers are private companies, they are able to provide adequate care for 13% of the family income and they are making money for their investors. Why can't they get it together in the US?

GREED and stupidity.

[ninjadude]

They can fine me.I won't be buying into it.

So then you ascribe to the Republican philosophy that when you get hurt in an accident, get cancer, or some other medical issue, you should just die?

[Sir Wearer of Hats]

We have health care for everyone in the UK. Called the NHS. It is like a giant cancer that is killing off the UK. I think they should introduce a £15.00 fee to see a doctor unless the person is on benefits.

That's the Australian system. I pay $60 out of pocket to see a GP and $80 a month in Private Healthcare. That's about 3 hours wages for me a month all told. We do get about $30 back from Medicare if we claim the rebate after a GP appointment though.

[FurthurBB]

I fail to see how that is any different from what we already had. Except insurance premiums have risen to where a lot of people, that have always had it, have had to let it drop. Independent working people and people that own small businesses don't have a chance.

I wish I could remember who said this on UM, but it makes sense to me...solving the health care problem by making people buy insurance, is like solving the homeless problem by making people buy homes.

If we aren't paying $2000 a month for insurance, for the two of us, we don't have a problem paying doctor bills. We just have to pray that nothing catastrophic happens.

My insurance has not gone up anymore since Obama got into office than it had been going up previously. Also, my benefits have gotten better. No fee for well visits and less for a specialist you have to see all the time, better mental health benefits and cheaper prescriptions. That is the first time that has happened.

[FurthurBB]

What I don't get is that in other countries they get it together, if we go back to Germany, 90% of the insurance givers are private companies, they are able to provide adequate care for 13% of the family income and they are making money for their investors. Why can't they get it together in the US?

That is really what it comes down to. Is there something wrong with us?

[+and-then]

My insurance has not gone up anymore since Obama got into office than it had been going up previously. Also, my benefits have gotten better. No fee for well visits and less for a specialist you have to see all the time, better mental health benefits and cheaper prescriptions. That is the first time that has happened.

It sounds as though you will benefit from the ACA. If 15 million uninsured people will now be covered by insurance then those companies are not going to "eat" the extra expense for things like free birth control or wellness visits, mammograms etc. They will add those expenses back into the system somewhere. Once the plan is fully operational you can anticipate longer waits for services and doctor visits too. Only so much staff and so many hours to the day.

There's no doubt the system needed change but I don't think the ACA is IT.

[ohio traveler]

So then you ascribe to the Republican philosophy that when you get hurt in an accident, get cancer, or some other medical issue, you should just die?

Why should I have to pay for your medical issue ?

[FurthurBB]

It sounds as though you will benefit from the ACA. If 15 million uninsured people will now be covered by insurance then those companies are not going to "eat" the extra expense for things like free birth control or wellness visits, mammograms etc. They will add those expenses back into the system somewhere. Once the plan is fully operational you can anticipate longer waits for services and doctor visits too. Only so much staff and so many hours to the day.

There's no doubt the system needed change but I don't think the ACA is IT.

Why does that not happen in other countries? I think that is the issue. Is it because we are so gullible that they can get away with overcharging us? Maybe, they sold a lot of people the myth that we are paying for other countries when that is so easily proven false. Is it because something is so much more broken here than other places? Are we less healthy than other countries? That is a possibility, we do seem to have a lot more issues with cancer, diabetes, and heart disease. Though in Asian countries they have more issues with genetic defects and they seem to do fine with healthcare. Is it because our government is so much more corrupt than others and are beholden to lobbyists? That is also possible, though I think some other countries that seem to be doing fine are pretty corrupt too. There has to be a way to provide affordable healthcare to everyone without diminishing quality. Doing nothing was leading to higher insurance premiums with lesser coverage, less people wanting to be doctors, and doctors leaving to practice in other countries, that is not good for anyone.

Edited April 4, 2012 by FurthurBB

[FurthurBB]

Why should I have to pay for your medical issue ?

I doubt you have the money to pay for anyone's medical issues but your own. I could be wrong, but that seems to be the case with people who spout this nonsense.

[Keel M.]

In the US they want to take over the German model, which is healthcare for all but you have to buy insurance from an insurance company (unless you can't afford it, then the government pays for you). The UK is healthcare for all paid with taxes

Last week I heard that all of Germany's insurance companies are non-profit. I think that's the biggest issue here in the US. The insurance companies are all about being FOR profit which is where the greed comes in. Perhaps if all of ours were non-profit like in Germany, it would be far easier for all of us to get the kind of healthcare we want/need on an individual basis.

[DoesntReallyLike]

So if funeral costs go up, can the government force you to buy funeral insurance so the living won't have to shoulder the burden? Or force you to buy a home gym to combat obesity, or to buy marijuana to combat glaucoma, or buy a new television to combat boredom? ( <-- stupid activist judges, trying to legislate from the bench! )

[Michelle]

My insurance has not gone up anymore since Obama got into office than it had been going up previously. Also, my benefits have gotten better. No fee for well visits and less for a specialist you have to see all the time, better mental health benefits and cheaper prescriptions. That is the first time that has happened.

Good for you...

Ours, however, went up $400 a month EACH in three years. That is $2000 a month we really couldn't afford.

When I went to the doctor last month they said that they had a lot more people coming in without insurance and paying cash.

[questionmark]

Last week I heard that all of Germany's insurance companies are non-profit. I think that's the biggest issue here in the US. The insurance companies are all about being FOR profit which is where the greed comes in. Perhaps if all of ours were non-profit like in Germany, it would be far easier for all of us to get the kind of healthcare we want/need on an individual basis.

There is only one big national non-profit and several local non-profits called Krankenkasse (and the are getting to be less and less as they shrunk from about 400 in 1999 to 48 in 2007). Generally they end up having all those as customers who cannot pay their own way (and that is why they were created). Then there are the so-called company bound insurance companies, which are non-profit but cater only to employees of a certain company (created to lower the costs, instead of 13% they charge between 10-13%) called Betriebskrankenkassen( We could get into the large amount of smaller companies that are non-profit but cater only to a small percentage of the population, like the so-called Knappschaften, which only cater to miners and exist since 1854 or the Artist Social Fund that is almost paid to 99% by tax money, but that just would muddy the waters as the beneficiaries are below 5% of the total population) and then there is the vast majority that are normal for profit companies called Ersatzkassen, some of them are also large insurers in other fields and share holder owned.

Now, you can insure yourself in two models:

One, as required by law, which means that you get the best standard treatment available (no exclusions) and the premiums are limited to 14.6% as wage earning or salary earning employee you also are entitled to 60% of your salary once you have depleted your sick-time(which is why the employers are asked to contribute) . Due to the competition among different companies the average premium is way below that. People with low income cannot opt out of anything there. And your premium is the same as everybody else regardless of how many times you got sick.

Two, with an adequate income, you can opt in or out of certain services (i.e. no dental, or only one-bed rooms in hospitals, out of pocket up to x thousand Euro, treatment only by University Department Head and so on) and negotiate your premium with the company. Adequate income here means that you must be able to pay the higher premium for additional services you opt into or must earn enough to pay out of pocket for what you opt out of (I don't know how much you have to earn in either case, have not been in Germany since the 90s). Some of these companies even offer money back if you did not get sick that year.

So, partially you are right, but that is hardly the whole picture. Fact is that big insurers have been displacing non-profit organizations since the market was liberalized in the 90s.

[Startraveler]

I fail to see how that is any different from what we already had. Except insurance premiums have risen to where a lot of people, that have always had it, have had to let it drop. Independent working people and people that own small businesses don't have a chance.

Independent working people are exactly the ones the insurance-related pieces of the health reform law are going to help the most. In part that's because they'll be eligible for financial assistance in purchasing plans. But in part it's because the individual health insurance market is on the verge of performing like a genuine competitive market in a way it hasn't to date.

Those independent working people will be getting a larger number of sellers offering more plans in a given market. They'll be gaining access to standardized quality and price indicators and actuarial numbers that allow sellers to send meaningful, readily understandable indicators to them as they shop for plans. They're getting a level playing field that will allow shoppers to choose the plan they like instead of being denied plan options by industry risk-shedding mechanisms. And on the fun side, they're getting consumer-friendly IT interfaces that allow very easy, real-time side-by-side comparisons between plan offerings of different carriers in the market.

If you really want to understand what's changing, you need to familiarize yourself with the deficiencies in the current health insurance markets and the remedies being developed to correct them: state-based health insurance exchanges.

Background

One of the great challenges in buying health insurance has been a highly fragmented market. Individuals and group purchasers lack a reliable means for seeing their choices in one place and in a manner that allows them to compare what the plans cover, which providers are in various plans’ practice networks, how cost-sharing might differ, and how numerous competing plans might compare on key measures of quality performance. Nor has there been an active, consumer-oriented system for assuring that insurance plans that are offered in the individual and small group markets provide comparable coverage, cover the benefits that are considered essential to any health insurance plan, have accessible provider networks, and are accountable for specific measures of health care quality. State insurance departments play a different role in most states, overseeing health insurers’ solvency and marketing and business practices. But typically insurance departments do not, as part of their work, organize the health insurance market to make it accountable and user-friendly to individual and group consumers.

Health insurance exchanges are designed to help individuals and small employer groups be better positioned to purchase high quality health insurance by creating “organized markets”[1] that simplify the job of selecting and enrolling in coverage and securing performance information about available products. Health insurance exchanges have been a key element of numerous health reform proposals; indeed, the concept of an exchange lies at the core of systems that turn on the competitive selection of health insurance products in the individual and group markets.[2] Massachusetts’ Commonwealth Health Insurance Connector Authority, established as part of the state’s 2006 health reform legislation, is probably the best known example of a health insurance exchange.[3] The Medicare Part D prescription drug benefit also utilizes an exchange concept as the means by which beneficiaries select their prescription drug plans. At the same time, there are several issues that can derail the development and functionality of exchanges, including adverse selection, a low number of participants, over-complexity, transparency and disclosure, and competition, among other things.[4]

A health insurance exchange might carry out numerous functions: helping individual and group purchasers calculate and compare (e.g., individuals versus families; older versus younger individuals; small versus larger employer groups); providing information about the plans and negotiating prices; helping purchasers gain access to available subsidies; and assuring that premium payments to plans are adjusted to reflect the level of health risk among enrollees (a practice known as risk adjustment) in order to assure payment fairness depending on the specifics of their products. For example, health plans may differ on the level of pharmacy benefits covered or may offer provider networks that are broader or narrower. Health plans’ provider networks may also perform differently on key measures of health care quality. Depending on these variations, plans may attract sicker versus healthier populations.[5]

Health insurance exchanges are designed to overcome a basic problem, namely the lack of a robust, organized market for the purchase of health insurance by individuals and small business. In the absence of an organized market, the price of coverage rises because of the additional costs incurred in marketing to and supporting thousands of small customers. In addition, the lack of an exchange means the absence of an organized group of individuals and small business purchasers across whom the cost of coverage can be spread.

Exchanges have the potential to serve large numbers of individual and group health purchasers across an entire region. As a result, they have the potential to make purchasing easier and more efficient than is the case in a highly fragmented market in which thousands of individual and small group consumers are attempting to navigate the health insurance marketplace with incomplete information. Comprehensive and transparent quality and pricing information across a full range of products can be made available in an organized and logical fashion.

[+DieChecker]

My problem with the ACA is that it requires that more services be funded with less money. You cannot add millions of people to the roles and expect the same level of service without drastically expanding the numbers of healthcare workers.

That is a problem I see with it too. You can't just keep throwing more money into a system that is bleeding out. You have to stop the bleeding first.

[/b]

GREED and stupidity.

True. True.

If 15 million uninsured people will now be covered by insurance then those companies are not going to "eat" the extra expense for things like free birth control or wellness visits, mammograms etc. They will add those expenses back into the system somewhere.

That is another thing that was not addressed enough I think. The "promise" was that rates would not go up and costs would actually go down. But, I've not seen how that is supposed to happen. The logic of it eludes me.

Last week I heard that all of Germany's insurance companies are non-profit. I think that's the biggest issue here in the US. The insurance companies are all about being FOR profit which is where the greed comes in. Perhaps if all of ours were non-profit like in Germany, it would be far easier for all of us to get the kind of healthcare we want/need on an individual basis.

Exactly right. It is because the Insurance Industry needs to post a profit. And they (The CEOs/Presidents/Board members) need to post an increase in profit every quarter so they can defend the large salaries they are drawing. The greed is at the top, and is driven not by goodwill, but by fear.

[conspiracybeliever]

I wonder how they supply the jails with health care but can't the rest of us. Do we have to work for .25 an hour? They do that with our tax money. Why can't they use our tax money for health care for the rest of us?

[ninjadude]

Why should I have to pay for your medical issue ?

A society has a vested interest in the good health of it's citizens.